Evidence-Based AAC Assessment:
Integrating New Protocols and
Existing Best Practices
Elizabeth (Libby) S. Rush, MA, CCC-SLP, CPM
AAC Specialist in Private Practice
[email protected]
Celeste R. Helling, MA, CCC-SLP, ATM
AAC Consultant
[email protected]
Resource CD
What’s on the CD that you will receive?
The information has a copyright but has been
made available for use in your various work
settings.
What is the Goal of AAC Assessment?
To facilitate the most effective
communication possible across a
variety of communication
environments, situations or
frameworks
Speech Language & AAC Evaluations
Traditional speech/language evaluation focus is
on describing the nature and extent of the
communication disability, estimating prognosis,
designing an initial framework for intervention.
AAC assessment assumes that the
communication disorder is chronic and that
natural language is not likely to occur. Therefore,
the focus on the assessment shifts to designing
an AAC system that will provide for the highest
level of generative communication that can be
achieved.
The Basis for Successful AAC Outcomes
Information
about
devices
and AAC
systems
Knowledge
about the
Client
EBP
Best Practices
Three Types of Information
EBP
Best Practices
Evidence Based Practice (EBP)
is a Decision Making Process
 Current high quality research evidence
 Clinician’s expertise
 Consumer’s values and preferences
Three Types of Information
Knowledge
about the
Client
Knowledge of client involves assessing
the individual, communication partners
and environment to identify
 Individual’s current communication
competencies, needs and goals
 The person’s strengths and abilities
 Possible barriers preventing the individual from
achieving his/her full communication potential
 The aids and adaptations needed to accomplish
the individual’s goals given his/her strengths and
abilities, and current circumstances?
Three Types of Information
Information
about
Devices
Knowledge about devices,
technology and systems
 While expert knowledge of devices is critical to outcomes, remember that
AAC is not just technology and devices.
 Technology discontinuance varies from 8% to 75% depending on type of
technology (About 1/3 of all technology is abandoned). Phillips & Zhao,
1993; Scherer & Galvin, 1994
 Technology is ever changing and it is critical that the practitioner knows
where to obtain reliable and objective information about technologies,
devices and aids
 Vendors most knowledgeable about their products and offer loan
programs
 Tech Act programs, lending libraries and demonstration centers
 The Internet, as well as traditional media, offers an array of
information
Thoughts on Testing
 It is the responsibility of clinicians to seek out, learn
techniques, strategies, approaches that will maximize
the potential AAC user’s
 There is no complete formal assessment tool or
battery of tests for AAC assessment
 Clinician must rely on having a comprehensive
understanding of communication, language and its
development to utilize and interpret procedures,
protocols and informal measures
 AAC evaluation involves more than assessing the
individual, it looks at the potential AAC user, the
environment and the communication partner
Thoughts on Testing
 Issues in AAC assessment are complex and at times,
teams over- evaluate; however incomplete
assessment can lead to erroneous outcomes
 Testing places time and energy demands on the
potential users and others which can be
counterproductive
 Assessment is not a one shot deal, it is an ongoing
process. Training, treatment or programming are
essential components of ongoing assessment or
follow along
Testing Guidelines
 How an individual responds to an evaluation task may give more
insight than whether the response is correct/incorrect
 Attempt to determine stimulability or potential for learning or
using various AAC systems
 Focus on what client can do not what can’t do
 Use pre-evaluation questionnaires & results from previous tests
to gain information
 Be transdisciplinary: observe and assess with others thus
avoiding duplication –make a video to share
 Testing can be tiring so have necessary materials prepared and
equipment available
 Don't test what is not needed
Components of AAC Assessment Process
 Preparation
 Potential AAC Candidate
Sensory/perceptual
Positioning/Access
Linguistic
 Communication continuum/Language
 Cognitive skills
 Literacy skills
 Communication Partners/Social Networks
 Environmental Factors
 System Selection – Feature Matching
 Completion of current assessment (report writing funding) is the
initiation of the ongoing evaluation process
Pre-Assessment Preparation
Questions at Initial Contact
 Preservice Questionnaire
Information that can be obtained prior to
assessment session
 Pre Evaluation Questionnaires
Obtaining previous reports, evaluations and
supplemental information
 Communication Questionnaire
Others AAC Techconnect.com
Assessment of the Individual
Sensory/Perceptual: Goal is to determine
size, type, placement of symbols and
identify language input and output options
Positioning/Access: Goal is to identify
optimal seating & positioning and motor
technique for access
Linguistic: Goal is to identify AAC
techniques & strategies & select types of
symbols
(adapted from Beukelman & Mirenda 2005)
Sensory/Perceptual
Goal is to determine size, type, placement of symbols
and identify language input & output options
Vision
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Visual Acuity
Visual Field
Oculomotor Functioning
Light Sensitivity
Color Perception
CVI
Incidence of Vision Problems
48% - 75% of children & adults with developmental disabilities and/or cerebral palsy*
75% - 90% of children with severe/profound cognitive disabilities*
Hearing
 Standard Assessment
 Functional Use of Hearing
*Augmentative Communication News, Vol 17, #4 December 2005 retrieved 10-04-2011
http://www.augcominc.com/newsletters/index.cfm/newsletter_34.pdf
ACCESS
Goal is to identify optimal seating & positioning
and motor technique for access
USER CHARACTERISTICS
 Identify Proper Position Don’t Wait for New Seating System
Reposition
Modify current
Recommend as appropriate
 Determine Anatomic Site/Action
What part(s) of the body & what action
will be used to activate the device
 Determine Potential Contact Surface (area on input device)
Identify the quality and orientation
of the functional movement pattern
ACCESS
USER CHARACTERISTICS - DETERMINE ANATOMIC SITE AND ACTION
What part(s) of the body & what action
will be used to activate the device?
Hierarchy of Anatomic Sites
Hands
Head/Voice
Feet
Arms/elbow
Legs/Knees
ACCESS
USER CHARACTERISTICS DETERMINE POTENTIAL CONTACT SURFACE
The Potential Contact Surface is the area on input device:
Identify the quality and orientation of the functional movement pattern
Range:
What is the client’s usable range (area and orientation)
Resolution:
How accurate is the movement
The minimum size of activation site, possible number of activation sites,
spacing of activation sites will be determined by resolution
Consistency:
Can the movement be made reliably and repeatedly
Strength:
How much force is needed to activate the device?
Speed:
How fast can user activate and release input device?
Energy-Expenditure:
How long or how often can movement be made
before client fatigues?
Will reflex stimulation affect the ability to use the
device
Can the client avoid making selections when not
intending to do so?
Reflex Stimulation:
Inadvertent Activation:
Size and Location & Activation Site Will be Determined by Resolution
ACCESS
Goal is to identify optimal seating & positioning
and motor technique for access
DEVICE ATTRIBUTES
Determine Input System Requirements
 Sensitivity
Amount of pressure/force needed to activate the cell/system
 Feedback Requirements
Tactile
Visual
Auditory
 Selection or Activation Method
Direct selection
Scanning
Encoding
ACCESS
DEVICE ATTRIBUTES
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IDENTIFY COMPEXITY OF INPUT DEVICE
Continuum of Input Devices
Keyboard
Mouse Technology
Proportional Joystick
Switched Joystick
4 Switches
3 Switches
Single Switch Scanning
2 Switches
Single Switch
ACCESS
Goal is to identify optimal seating & positioning
and motor technique for access
SYSTEM REQUIREMENTS
Implications for functional use of system
 Mounting
 Portability
 Transferability
 Flexibility
 Ease of setup
 Visibility
 Backup systems
 Independent access
 Access to other technologies
 Other users
 Access to activities (dining,
work, school, leisure)
ACCESS
 Assure that access method can be used repeatedly without
fatigue, discomfort or embarrassment across all
environments
 Identify possible need for multiple means of access
 In summary the access assessment identifies device
features and system input requirements including
minimum size of the activation site and possible number,
sensitivity, selection methods, and physical access
 During assessment or device trials consider offering
systems that match personality of user
LINGUISTIC
Goal is to identify AAC techniques & strategies &
select types of symbols
 Cognition: Examines how individual perceives world
and how might use communication within his
understanding
 Communication/Language: Assesses the individual’s
skills on the communication continuum from emergent
to context dependent to independent. Examines use of
a single word vocabulary to common language
structures
 Symbol Selection: Examines how an individual can
communicate with symbols & possible symbol types
 Literacy: Assesses reading, spelling, and writing skills
LINGUISTIC
Cognition – Language – Communication
 Many of these assessments have been performed
prior to an Augmentative Communication Evaluation
and results should be obtained from those
evaluations
 Modification of existing assessment instruments may
be necessary along with the expertise to interpret
results; requires sound knowledge of language
development and communication, and understanding
of what each test is designed to assess
 Informal assessment are often necessary when
standardized tests are not sensitive enough to
accurately depict levels of communicative functioning
COMMUNICATION CONTINUUM
Continuum of Communication Independence
A continuum used to describe an individual's
expressive communication based on observable
communication behaviors that is useful in
intervention planning.
Patricia Dowden, Ph.D., CCC-SLP Clinical Assistant Professor
University of Washington
http://depts.washington.edu/augcomm
COMMUNICATION CONTINUUM
Continuum of Communication Independence
Emergent
Does not have a reliable method of expressive
communication through symbolic language
Not indicative of cognitive deficits
 Tends to rely on non-symbolic communication
strategies
Patricia Dowden, Ph.D., CCC-SLP Clinical Assistant Professor
University of Washington
http://depts.washington.edu/augcomm
COMMUNICATION CONTINUUM
Continuum of Communication Independence
Context Dependent
Symbolic communication is reliable, but
limited to particular contexts or partners
 Relies on AAC techniques with vocabulary
chosen by others
 AAC strategies that are effective only with familiar
partners
Patricia Dowden, Ph.D., CCC-SLP Clinical Assistant Professor
University of Washington
http://depts.washington.edu/augcomm
COMMUNICATION CONTINUUM
Continuum of Communication Independence
Independent
 Not limited in what they can talk about or whom
they can talk to
 The ability to communicate anything on any topic
to anyone in any context
Patricia Dowden, Ph.D., CCC-SLP Clinical Assistant Professor
University of Washington
http://depts.washington.edu/augcomm
COMMUNICATION CONTINUUM
Assessment Goals
 Emerging Communicators
Identify that 1st method of symbolic communication.
 Context-Dependent Communicator
Identify the SGD that will expand vocabulary and
partners and contexts
 Independent Communicator
Evaluate their goals and desires for improved
communication
At all levels of the Continuum, the evaluation should also provide
recommendations for AAC/SGD implementation strategies and
intervention
LINGUISTIC
Literacy
 Goal for AAC assessment is to identify where
individual is on the continuum from emergent to
conventional literacy
 Formal literacy assessments may have been performed
prior to an AAC Evaluation and results should be
obtained from those evaluations
 Modification of existing assessment instruments may
be necessary along with the expertise to interpret
results; requires sound knowledge of literacy skills and
an understanding of what each test is designed to
assess
 Informal assessment may be necessary for those with
emerging literacy skills.
LINGUISTIC
Symbol Selection
 Practitioners must be familiar with the variety of
symbol sets and understand the characteristics and
features of each symbol system to aid in identifying the
appropriate system for each individual
 Critical to remember that symbols are learned
 Selection of symbols will be dependent on sensory,
cognitive and perceptual issues as well as individual
preferences
 There is not a hierarchy of symbols but rather a
continuum
 Symbol selection should be based on current needs
and future considerations
Symbol
Selection
COMMUNICATION PARTNERS
 Are there partners who recognize and
acknowledges need for AAC and appropriate
positioning?
Are there partners who have the skills and
opportunity to assist in setting up or programming
the device?
Are the expectations of communication partners
on target or realistic?
Collect information through observation and
interview
ENVIRONMENTS
Environments might include physical space, people
present, emotional atmosphere, situation, activity or
task
Work with communication partners to identify all
environments and what needs to be communicated in
each of those
Identify needs for accommodations or modifications to
physical environments, routines, or tasks
Communication Supports Checklist from National Joint
Committee for the Communication Needs of Persons
with Severe Disabilities (McLean, Miller, Paul-Brown,
Romski, Rourk, Yoder, & McCarthy) – available used
from various online dealers
TOOLKIT - see resource CD
Objects, photos and symbols
Dry erase board
Display board with Velcro sensitive fabric
Sequencer
Progressive communicator
Auditory choice making communicator or Talk 4 with levels
Switch activated devices (toy or fan or vibrating Pillow)
Battery adaptor
Array of Switches
Switch Interface
Switch Mounting system
Laptop computer or tablet computer
Touch Screen
Dynamic Display Software
Download AAC Evaluation Genie
PowerPoint
AAC Assessment Toolkit Resources
 Toolkit Resources 2011
Digest of cost-effective assessment tools
needed for a basic AAC Evaluation Toolkit
 AAC Lite Tech Evaluation Toolkit
www.enablingdevices.com
 ACES Toolkits and Evaluation Assistant
• www.aactechconnect.com
 GPAT Toolkit Chart
–See resource CD
AAC Lite Tech Evaluation Toolkit
Enabling Devices
ACES Toolkits
www.aactechconnect.com
Assessment Instruments
 Limited selection of formalized and
standardized AAC assessment tools
 Must adapt and modify existing instruments
 Must search for and find additional protocols, tools and techniques
 Must have expertise to interpret
informal/nonstandardized assessment
 Insufficient availability of formal tests often
results in unorganized and incomplete
recording of what was tested, how it was
tested and exact results
 Regardless of the type of assessment used,
thorough documentation is necessary to
communicate results across people and time
Sensory Assessment
 Locate an ophthalmologist or optometrist who is sensitive
to testing those with disabilities
 Gather as much information as possible prior to assessing
so that there are appropriate materials and supports for the
evaluation
 When assessing always consider lighting, contrast, size of
symbol/print, color, near & distance viewing, placement,
number of items, and visual discrimination
 Employ guidelines and suggestions to address visual
factors (Visual Considerations for Students Who Use AAC
PA Dept. of Ed.)
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 Utilize VI specialists when available
Access Assessment
 Critical to have professional assessment of seating
and positioning to assure that individual is positioned
correctly
 Employ checklists and guidelines to assure that there
is a comprehensive assessment of functional
movement patterns (Feature Matching Checklist
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Adaptive Switch Assessment by P. Justice)
 Utilize various sizes activation sites such as
symbols/pictures, switches and input devices as well
as potential mounting systems
 Utilize materials and manipulatives that are motivating
to the individual
Assessment of Functional Communication
Assessment of Functional Communication for
Individuals with Intellectual Disabilities
A formalized, comprehensive review of the
various functions of communication and the
daily environments in which communication
occurs.
This assessment permits examination of the
contextual and interactive aspects of
communication not measured by standardized
tools.
It has been designed to examine communication
at unintentional, early intentional and intentional
levels.
Information collected through observation,
elicitation and reported behaviors.
Literacy Assessment Tools
Concepts in Print
Home Literacy Inventory
The PAL Assessment
The Bridge
The Troll
Adult-Child Interactive Reading
Inventory
Literacy Assessment Tools
 Concepts in Print
 Can purchase from www.heinemann.com or
www.amazon.com
 Home Literacy Inventory
 The PAL Assessment
 Can purchase from www.slatersoftware.com
 The Bridge
 The Troll
 Adult-Child Interactive Reading Inventory
 http://www.ciera.org/library/reports/inquiry-2/2-004/2004.pdf (free)
 http://www.brookespublishing.com/
Concepts of/about/in Print
Marie Clay
http://www.heinemann.com/
Assessing concepts of print
refers to determining
how well the individual
understands how print is
used
Concepts about Print Assessment:
Might Include
Book orientation
Which way to read (start)
Front and back of book
Beginning and ending of book
Title
Graphics have meaning
Left to right
Words not graphics is way to
read book
Concepts about Print
Concepts about Print Assessment
(demonstration)
http://teams.lacoe.edu/documentation/classrooms/patti/k1/teacher/assessment/print/conceptsqt.html
Concepts of Print Assessment (example)
http://web.archive.org/web/20040630063110/wilearns.state.wi.us/app
s/PDF/print_prompts.pdf
Concepts about Print Assessment (example &
demonstration)
http://www.readingrockets.org/firstyear/fyt.php?CAT=6
Concepts about Print
Concepts of Print Assessment (Example &
Demo) http://www.mlppmsl.net/assessments/conceptsofPrint/default.htm
Concepts About Print Assessment Data
(Example, Recording Forms and Implications
for Teaching Concepts )
http://rwproject.tc.columbia.edu/assessments/reading
Concepts of Print Assessment (Presentation
on Marie Clay’s Assessment Tool
http://www.coe.uga.edu/epltt/impaticas/Concepts-of-Print.html
Home Literacy Inventory
Designed to reflect current and past family
interactions with print and print-related
conversations
Interventionists are guided to look at non-print
activities, reading activities, writing activities
and current reading and writing abilities.
Information may be gathered over time either
directly from the inventory completed by the
family or on home visits by the intervention
PAL (Picture-Assisted Literacy) Assessment
Complements Picture Assisted Literacy
Slater Software
 Intended to identify behaviors
in communication, reading and
writing.
 Designed to determine use and
understanding of symbols for
communication and for using
pictures to support reading
and writing text.
 Items describe student
behaviors with examples.
 Each booklet has four
http://www.slatersoftware.com/ scoring/observation periods to
monitor/track progress.
The Bridge
Designed to Investigate
Literacy and Language Development
• Foundations of Reading
(Book Knowledge/Appreciation/Print
Awareness/Story Comprehension)
How individual interacts with books
How child interacts with symbols/print?
How person engages in the act of reading?
• Foundations of Writing
How individual draws/writes (Motor item)
How child uses print? (Cognitive/linguistic item)
How person writes his name? (Motor & Cognitive
item)
How individual interacts with/uses letters of the
alphabet?
The Bridge
Designed to Investigate
Literacy and Language Development
Phonological/Phonemic
Awareness
How individual demonstrates phonological
awareness
How child demonstrates phonemic awareness
Oral Language
(related to literacy activities)
How individual interacts during literacy related
activities
How child engages in story telling
The Troll
The Teacher Rating of Oral Language and Literacy
Designed to track literacy and language
development
For use by classroom teachers or reading
specialists
No formal test training needed
Administered for each child in app. 5
minutes
Can be reused over year to track progress
Adult–Child Interactive Reading Inventory (ACIRI)
By Andrea DeBruin-Parecki
http://www.brookespublishing.com/
http://www.ciera.org/library/reports/inquiry-2/2-004/2-004.pdf
Measures quality of interactions
between adult and child during
shared reading
Assesses child and adult
behaviors in these areas:
 Enhancing Attention to Text
 Promoting Interactive Reading
 Supporting Comprehension, and
Using Literacy Strategies
Includes intervention activities
AAC Assessment Tools
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Social Networks
Communication Partner Skills
TASP
Inventory of Symbolic Functions
SETT
WATI
Triple C – Checklist of Communication
Competencies
Augmentative & Alternative Communication Profile
A Continuum of Learning
Communication Matrix
SGD’s
AAC Evaluation Genie
AAC Assessment Tools
Social Networks
Communication Partners
 Written by Sarah Blackstone
and Mary Hunt-Berg,
available from Attainment
 Enables collection of
information from individuals,
their families, and involved
practitioners, about their
communication partners and
current modes of expression
to assist in guiding and
refining intervention
 Based on principles of
functional goal setting and
person centered planning
AAC Assessment Tools
Communication Partners
Communication Partner Skills
Draft of checklist to
collect information
about communication
partners and
communication
environment.
Will utilize observation,
direct inquiry or
reported information.
AAC Assessment Tools
Test of Aided-Communication Symbol Performance
(TASP)
A tool for the assessment of symbol-based
communication skills
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Symbol size and number
Grammatical encoding
Categorization
Syntactic performance
Establishes basal &
ceiling for each subtest
AAC Assessment Tools
Inventory of
Symbolic Functions
 Designed for use with children or adults
 Determine individual’s potential for using
symbolic communication,
 Identify the type of symbol set that meets
the strengths/weaknesses of individual
 Ascertain the possible size, number and
position of symbols.
 Examines word knowledge, stimulability
for learning symbols skills in
categorization of concepts.
 Addresses objects, cut out photos of the
objects, photographs, and graphic
symbols
 based on core vocabulary for children and
for AAC vocabulary used by adults and
clinical experience of the authors
AAC Assessment Tools
Student, Environment, Task, and Tool Framework
(SETT)
 The Student
• Abilities and Current Communication Needs
 The ENVIRONMENT
• Available Supports and Tools
 The TASKS
• The Student Needs to Perform in Each Environment
 The TOOLS
• Assistive Devices and / or Techniques Needed for the
Student to be Successful
AAC Assessment Tools
 WATI adapted the SETT framework across
all AT domains
 Assessing students' needs for assistive
technology (ASNAT) 5th edition
 16 chapters; chapter 3 AT for
communication
 Each chapter includes a comprehensive
assessment and intervention guide
AAC Assessment Tools
The Triple C – Checklist of Communication
Competencies Revised Edition 2009
by Karen Bloomberg,Denise West , Hilary Johnson & Teresa Iacono
available from Resource Center-SCOPE Box Hill, Vic Australia
Designed for use with
adolescents or adults with little or
no speech. Assesses early
functional communication skills.
Can be used by untrained
communication partner though it
is recommended that a
communication specialist be part
of confirming the final results.
http://www.scopevic.org.au/index.php/yiiCart/frontend/product/product/path/1_3/id
/3
AAC Assessment Tools
A Communication Independence Model:
For People with Severe Communication Disabilities
by Yvonne Gillette, The University of Akron
Attainment Company
http://www.speechpathology.com/articles/article_detail.asp?article_id=215
Designed for use with individuals with complex
communication needs of all ages. Assesses
communication opportunities and skills. Provides
strategies for intervention based on the
information gathered in the assessment process.
AAC Assessment Tools
Augmentative & Alternative Communication Profile
A Continuum of Learning
Tracy M. Kovach, Ph.D., CCC-SLP
Contains four Areas of Learning
(Operational, Linguistic, Social and
Strategic) adapted from of J. Light
[1989]). Each area assesses skills
through five ability-based levels called
Skill Set Levels. Measures subjective,
functional skills. Developed for children
using speech generating devices and
can be used for adults who do not have
acquired communication disorders and
use AAC.
AAC Assessment Tools
 Communication Matrix
www.communicationmatrix.org
 Communication Assessment for Parents &
Professionals
 Assessment protocol for individuals of all
ages who function at
the earliest stages of
communication
 Evaluates 7 levels of
communication from
pre intentional to symbolic language
AAC Assessment Tools
 Virtually all manufactures include some
level of AAC assessment within their
SGD’s.
 Usually are very short screening protocols
 Good choice to use as a screening
measure to get a “snapshot” of language
and access capabilities.
Developing The Language Representation Model
With Persons With CCN
Diagnostic trials should be geared
towards collecting observations that
enable the evaluator to begin to build a
working hypothesis about how the
person’s language skills work to
support AAC techniques.
Language Representation
Building word based AAC systems are a
priority over phrase based systems
 Follows developmental language models
 Builds a stronger foundation for both
word fluency and literacy development
 Leads to generative communication
capabilities
Language
Learning
AAC Evaluation Genie
 Informal diagnostic tool to evaluate the skill
areas that relate specifically to the language
representation methods commonly found on
augmentative communication systems.
 Not intended to identify a particular device,
but rather build a framework for selecting an
appropriate AAC device for ongoing
evaluation and / or device trial.
 The entire protocol can be administered in as
little as 17 minutes using
touchscreen/mouse, 30 minutes using linear
scanning (fast) and 20 minutes using
headpointing (1 second dwell).
AAC Evaluation Genie
 AAC Evaluation Genie
 Includes10 subtests
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Visual Identification
Visual Discrimination
Noun Vocabulary
Verb Vocabulary
Function Vocabulary
Category Inclusion
Core Vocabulary
Icon Patterns
Picture Description
Word Prediction
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AAC Evaluation Genie
Visual Identification & Discrimination subtest evaluates
symbol identification, tracking and discrimination across an
increasingly complex gird array.
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Vocabulary subtests evaluates basic vocabulary
identification, organization and generalization of meaning
across contexts.
Core Vocabulary and Patterns evaluate ability to recognize
multiple associated word meanings.
Picture Description: Evaluates the basic ability to sequence
symbols to describe a picture. Yields a mean length of
utterance in words.
Word Prediction: Evaluates ability to identify a target word
from a list of choices.
AAC Evaluation Genie
 AAC Evaluation Genie Features
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Comprehensive Data Tracking
Access Methods
• Touchscreen/Mouse
• Linear Scanning
• Dwell / Headpointing
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 Freeware
 Available at www.humpsoftware.com
Given this information about the user,
additional diagnostic probes are
administered to evaluate language use
and complexity, as well as
stimulability for further cognitivecommunication development.
Stimulability Assessment
 Part of the assessment process is evaluating the
persons prognosis for further cognitivecommunication development
 Explicitly tied to clinician expertise
 Recall and retrieval of vocabulary and newly learned
symbols
 Parts of speech recognition and usage
 Responsiveness to expectant delay strategies
 Responsiveness to aided language stimulation & SGD
modeling
Diagnostic Activities Generalities
For persons with weak categorization skills,
use a static display
 This does not mean a low tech display
 Many persons are able to use Unity with the activity
row to support fringe vocabulary needs
 Picture Word Power Phrases and Categories is an
excellent language representation system for
persons with symbol sequencing deficits
Diagnostic Activities Generalities
 Probe basic semantic relations constructions
 Follow Browns Stages to assess morphology
use and/or stimulability
 Use familiar and readably available tools
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Puzzles
Illustrated books
Music
Animal scenes
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Mr. Potato Head
Cars
Bubbles
Trucks
At this point, you can start thinking about how
the persons language skills function, and what
SGD functions will support their need for
augmentative communication.
In other words, you have gathered enough data to
“paint a picture” about how the persons language
skills are working for them
Evaluation Session Resources
 Attempt to talk with all participants at the beginning and
end of each evaluation session
 Provide written summary at the conclusion of each
session
 Means of sharing information that helps everyone to understand what
was done
 Way to communicate what will happen next
 Method of recording information to use for report writing
Evaluation Consult Summary
 Utilize a method or form to provide consistent means of
recording information during the evaluation session
 Use of form helps to promote an organized method for
keeping work records
Evaluation Notes Form ◀
▶ Contact Log
AAC Feature Matching
 Matching Persons To Technology
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A successful match of person and technology
results from examining
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Characteristics of the Milieu
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Salient Characteristics of the assistive technology itself
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The environment(s) in which the technology will be used
Pertinent Features of the Personality, Preferences, and
Temperament
The needs and preferences of the user
The functions and features of the technology.
If the match is not a quality one from the standpoint of the
consumer, the technology may not be used, or will not be
used optimally.
AAC Feature Matching
Predictive Assessment that attempts to match:
The language representation and hardware
features of AAC systems
The access methods of AAC system
The feedback methods of an AAC system
To the current and future capabilities and
needs of individuals with complex
communication needs.
AAC Feature Matching
How Does Feature Matching Fail The AAC User?
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Focus is solely on current needs and abilities without
considering anticipated future needs and capabilities.
AAC team overemphasizes (caught up) with device
features.
Fails to take into account the user’s preferences while
negotiating a device recommendation that will support
current or future abilities for generative communication.
A “match” and capabilities to use a device does not
account for all of the components needed for success.
The whole is more than the sum of it’s parts.
AAC Feature Matching
 Additional features that are highly desired
(telephone, ECU, texting)
 External factors that influence feature
matching process
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Funding issues
Skilled provider
Motivation
Support
AAC Feature Matching:
Features To Consider
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Type and number of messages, vocabulary size,
coding system, symbol sets, message retrieval.
Size, layout, system memory, optical indicators,
auditory prompts, rate enhancement,
programmability, computer compatibility.
Type of input method (e.g., switches, mouth stick,
head pointer, alternative keyboard, and direct
selection, scanning, encoding).
Type of output (e.g., speech print, LCD, Braille).
Mounting and portability.
Extent of training required to use the system and
availability of training and technical assistance for
its use.
Availability of customer service by manufacturer or
supplier.
AAC Feature Matching:
Features To Consider
AAC Feature Matching:
Physical Considerations
 Direct selection
 Manual, head pointing, headpointing, eye gaze
• Indirect selection
 Switch access site
 Single switch vs. Switch array
 Scanning pattern
 Scanning / switch feedback
 Interpreted eye gaze access / e-tran
 Partner assisted scanning
 Wheelchair / switch mount / walker attachment
 SGD weight considerations for ambulatory user
AAC Feature Matching:
Physical Considerations
Hierarchy of switch access sites
 Hands
 Head/voice
 Arms/elbow
 Legs/knees
 Feet
Two or more input methods may use
multiple sites for access
AAC Feature Matching:
Sensory Considerations
Visual field and perceptual considerations
Display size
Magnification of icons, text
Auditory scanning
Tactile symbols
Braille symbols
Visual output???
AAC Feature Matching:
Cognitive Considerations
Attention
Task focus
Literacy level
Symbol recognition
Executive functions
Memory impairment
Language impairment
Metalinguistic skills
AAC Feature Matching: Other Considerations
 Consumer preferences
 Family / peer / support
 Educational support / needs
Vocational support / needs
 Skill of communication partners
 Motivation to communicate
 Funding source requirements
 SGD battery capacity
 Intervention and follow-along support
 Will the SGD meet current and future needs?
AAC Feature Matching: Protocols
Grid or worksheet based designed to
synthesize assessment data to AAC device
feature needs and identify possible devices
for recommendation.
Areas of assessment are translate to feature
match guide for AAC
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Motor Capabilities
Literacy Assessment
Positioning and Seating
Cognitive/Linguistic Capabilities
Sensory/Perceptual Assessment
AAC Feature Matching: Protocols
Grid or worksheet design
AAC Feature Matching: Protocols
Grid or worksheet design
Organizing and Summarizing Data
 Summary of Language Usage, Organization,
and Representation
 Feature Matching – Device Selection
Worksheet
 Report writing is often an important part of the
decision making process since many clinicians
use this process as a time to summarize and
analyze all of the information, data and insights
collected.
 Having an evaluation format can assist in
assuring that all areas of assessment have been
addressed
AAC Feature Matching: Electronic Database
AAC TechConnect
 AAC Tech Connect Device Assistant (DA)
⓿http://www.aactechconnect.com/
 Provides a feature-match tool to search for AAC devices
 Specifications for up to 40 different categories for each device
 AAC Tech Connect App Assistant
http://www.aactechconnect.com/
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Provides a feature-match tool to search for AAC Apps for Idevices
Apps meet a criteria for inclusion
Over 120 Apps reviewed
Available November 2011
Device Knowledge
Analyzing & Reviewing Devices
 Short Review or In-depth review
Resources
• The Resource For Lite Tech Low Cost AAC Chart
Special Education Technology - British Columbia
 AAC Device High Tech Feature Comparison (2008)
 AAC Device Low Tech Feature Comparison (2008)
AAC Vendors
 Websites
 Charts
 Catalogs
Device Trials
Arrange for and/or conduct device trials or loaner
periods
Good start for identifying vocabulary needs
Person(s) performing or assisting with trials
must be familiar with the device to assure an
effective examination period; vendors can be an
excellent resource for training and support
Findings from Brown & Johnson (2004) stated
that some subjects indicated that being able to
try out a device before buying was a factor
leading to successful use of AAC
Reports Resources
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www.aacinstitute.org
www.aacfundinghelp.com
www.aacproducts.org
www.aac-rerc.com
www.aactechconnect.com
www.asha.org
www.tobiiati.com
www.cms.hhs.gov/medicare/
www.cms.hhs.gov/states/default.asp
www.dynavoxtech.com
www.prentrom.com
www.words-plus.com
www.zygo.com
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Ongoing Review
Follow Along
Confirm that the system continues to work for the
AAC user
Establish that vocabulary and symbol selections
remain relevant
Determine if communication needs have changed
Ascertain whether communication partners have
and use the tools necessary for maximizing
communication
Survey environments for changes; decide
whether system should be altered to fit
environment, or vice versa
References
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Achieving Success in AAC: Assessment and Intervention, Katya Hill, Ph.D., CCC-SLP. Retrieved
October 18, 2010 from
http://www.aacinstitute.org/Resources/Press/AssessmentModelpaper/aacsucc.html
Beukelman, D.R., & Mirenda, P. (2005). Augmentative and alternative communication: Supporting
children and adults with complex communication needs (3rd ed.). Baltimore: Paul H. Brookes
Bloom, L & Lahey, M. Language development and language disorders. New York, Wiley, 1978
Bowen, C. (1998). Brown's Stages: The development of morphology and syntax, Retrieved from
http://www.speech-language-therapy.com/BrownsStages.htm on 10/04/2011.
David Beukelman. Models of AAC Assessment and Intervention, 04/02/99 Retrieved from
http://aac.unl.edu/drb/AAC_Assessment/index.htm
Galvin, Jan C. & Scherer, Marcia J. (1996). Evaluating, Selecting, and Using Appropriate Assistive
Technology. Aspen Publishers, Inc. Gaithersburg, MD
Fishman, Iris (2011) Guidelines for teaching speech-language pathologists about the AAC
assessment process. Retrieved from Perspectives on Augmentative and Alternative Communication
http://journals.asha.org/perspectives/terms.dtl 09/06/2011
Hill, Katya Data Collection and Monitoring AAC Intervention in the Schools. Perspectives on
Augmentative and Alternative Communication 2009 18: 58-64
Light, J.C., & Binger, C. (1998). Building communicative competence with individuals who use
augmentative and alternative communication. Paul H. Brookes Publishing Co.: Baltimore, MD.
Reichle, J. Beukelman, D. & Light, J.(2002) Exemplary practices for beginning communicators:
implications for AAC. Baltimore, MD Paul H. Brookes.
Rush, Elizabeth & Helling Celeste. New Ways to Jump Start Your AAC Evaluation Process: Including
a Free Evaluation Protocol and Cost Effective Items for an Updated Toolkit. Closing The Gap 2010
Schlosser, R. W. (2004, June 22). Evidence-Based Practice in AAC. The ASHA Leader.
WATI (2009). Assessing Students’ Needs for Assistive Technology Chapter 3: Communication.
Wisconsin Assistive Technology Initiative. http://www.wati.org
Wilson, B., & Risucci, D. (1988). The early identification of developmental disorders and the
prediction of the acquisition of reading skills. In R. Masland & M. Masland (Eds.), Preschool
prediction of reading failure. Parkton, MD: York Press.
Elizabeth (Libby) S. Rush, MA, CCC-SLP, CPM
AAC Specialist in Private Practice
[email protected]
919-471-2819
Celeste R. Helling, MA, CCC-SLP, ATM
AAC Consultant
[email protected]
704-566-2899